Hyper friend needs help with monitoring

[Guest guest]

I have a friend who has been monitored regularly for several years for

subclinical hyperthyroidism and a multinodular goiter. Recently she

started ATD's. Here are her numbers:

7.24.01 AND 7.1.02 (results were identical; DEXA in 2001)

TSH <.05

FT3 5.0 (1.1 - 4.7)

FT4 2.1 (0.6 - 2.2)

DEXA showing mild ostopenia

(Endo would only recommend RAI which friend declined; becase of no hyper

symptoms he was willing to let it ride with regular monitoring.)

8.12.02

TSH 0.0

FT3 not done

FT4 1.44 (0.7 -1.48)

serum Ca 9.5 (8.4-10.5 mg%)

Letter to patient says: The gamma camera image revealed a rapid and

irregular tracer uptake throughout a multinodular goiter that was

approximately 1.5 times normal size. Antithyroglobulin antibodies and

thyroid peroxidase antibodies were undetectable. A biochemical profile

including postprandial glucose was perfectly normal. The

blood count was normal with a hemoglobin at 14.3 grams.

New endo in August. Good for her because her we share an ex; this new one

was highly recommended. Here's where it starts to get bothersome: He

recommends RAI but since she refuses will start her on Tap, 10 mg.

2x/day. He doesn't tell her to space it approx. 12 hours apart but to

take with breakfast and dinner. He wants to recheck in two months. NOT

one month like even our ex did to also measure liver and WBC.

10.14.02 (same ranges as Aug.)

TSH 0.0

FT4 0.96

Apparently he didn't do a liver profile and WBC.

Dr. says to stay at current dose and come back in 2 months.

12.17.02 (same ranges)

TSH 0.1

FT4 0.89

Dr. wants her to increase the Tap to 15 in morning and 10 in evening.

Yes, increase to 25. She is trying to contact him to find out why since

logic dictates a reduction might be in order, to say 15 mg./day.

When she contacts him about this should she also ask for further testing?

She hasn't had a reaction so I suppose the liver panel is no longer

necessary. Any other antibodies, etc?

Also, her newer dr.is calling what she has mild toxic multinodular

goiter. Is this Graves? Not that it terribly matters.

Thanks and take care, Fay

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